Does History of Medicine Teach Useful Lessons?

DOES HISTORY OF MEDICINE TEACH USEFUL LESSONS? PLINIO PRIORESCHI* These are bad times for the humanities. From the media we learn that 25 percent of Americans are functionally illiterate, and horror stories of ignorance abound [1, p. 17b]. Latin, Greek, history, philosophy, and literature have either been eliminated from or are the Cinderellas of our school curricula. History of medicine is one of the humanities, and its status in our medical schools has not improved much since 15 years ago, when "a spreading indifference" was noted "among most medical schools that, however much they may praise the virtues of medical history , never did anything to promote it" [2]. Much has been written and much debate has taken place about the role of the humanities in medicine [3], and the question, "does history of medicine teach useful lessons?" is often asked. We ask it of ourselves to justify our own interest in the subject; it is asked of and by medical school faculties and administrators to decide what emphasis and monies should be assigned to it; and it is asked by anybody interested in the problem of how much we can learn from history. Does history of medicine teach useful lessons? The dictionary defines useful as "suitable to use," and "advantageous, profitable, beneficial." The two definitions differ in directness and specificity. The first indicates that what is useful can be put to use for the direct solution of a specific problem, whereas the second can be interpreted as meaning that what is useful is beneficial or advantageous not directly for a specific purpose but in some indirect and less specific way. Medical history is useful in the second sense but not in the first. As a consequence, if by "useful lessons" we mean instructions or suggestions for the direct solution of a specific problem, the answer to the question, "Does history of medicine teach useful lessons?" is no. *Department of Anesthesiology, Oregon Health Sciences University, Portland, Oregon 97201© 1991 by The University of Chicago. AU rights reserved. 0031-5982/92/3501-0743$01.00 Perspectives in Biology and Medicine, 35, 1 ¦ Autumn 1991 97 The reason is evident. Whereas other disciplines are useful for doing something (with medicine we cure diseases, with mathematics we build bridges, with geology we predict earthquakes, etc.), we all know that history of medicine does not help in diagnosing pneumonia or in removing a gallbladder or in treating cancer. The only thing we can do with the immediate and direct help of the history of medicine is write papers or books pertaining to it. The idea that medical history is not useful for the direct solution of specific problems is not new, of course. More than 30 years ago, at a meeting of the Institute of Social and Historical Medicine of the New York Academy of Medicine, where the utility of medical history was discussed, not a few among those invited were somewhat troubled by the emphasis on utility. Medical history, they protested, could not prove useful, that is of utility, as does, say pharmacology or pathology, or biochemistry. Medical history, they insisted, is not a tool. It isn't usable, as mathematics is usable. [4, p. 4] Those protesters were eventually overcome. Since then, we have tried desperately to show, albeit with little success, that medical history is useful for all kinds of purposes. It has been suggested, for example, that familiarity with history may help in taking the patient's history [5, pp. 27-28] (an odd belief), that lack of historical perspective may lead us to the error of believing that "what we do today [in medicine] is the best that has ever been done" [5, p. 25] (as if it were not true—see below), that a carefully considered undertanding of the history of medicine is fundamental to the development of newer methodologies [6] (one wonders how), and that the understanding of the history of medicine is important for the acquisition of clinical competence [7] (whereas common experience shows that there are many excellent clinicians who know little of the history of medicine). In the current discussions concerning the duty of the surgeon to risk his life by operating on the AIDS...